Limited Network Plans - Great Value, Quality Coverage

Limited network plans help address differences in provider costs. You will enjoy the same benefits as the wider network plans, but will save money because limited network plans have a smaller network of providers (fewer doctors and hospitals). Your savings depend on:

For participating physician and other provider details, contact the individual plans by phone or visit their website .

The GIC’s limited network plans are:

Fallon Health Direct Care - an HMO available throughout central Massachusetts, Metro West, Middlesex County, the North Shore and the South Shore. The plan includes 26 area hospitals and another five “Peace of Mind” hospitals in Boston that provide second opinions and care for very complex cases.

Harvard Pilgrim Primary Choice Plan - an HMO with a network of 55 hospitals. The plan is available throughout Massachusetts, except for Cape Cod, Martha’s Vineyard, Nantucket, and parts of Berkshire County.

Health New England - a western Massachusetts-based HMO that also covers parts of Worcester County and includes 18 Massachusetts hospitals.

NHP Care (Neighborhood Health Plan) - an HMO with a provider network that includes community health centers, independent medical groups and hospital group practices, as well as 57 hospitals. NHP Care is available across most of the state except for Berkshire, Franklin and Hampshire Counties.

Tufts Health Plan Spirit – an EPO (HMO-type) plan with a network of 53 hospitals. The plan is available throughout Massachusetts, except for Martha’s Vineyard, Nantucket and parts of Berkshire and Hampshire Counties.

UniCare State Indemnity Plan/Community Choice - a PPO-type plan with a network of 53 hospitals. All Massachusetts physicians participate. The plan is available throughout Massachusetts, except for Martha's Vineyard and Nantucket.

! Your Responsibility Before You Enroll in a Plan

Once you choose a plan you, cannot change health plans during the year, unless you move out of the plan’s service area or within 30 days of certain qualifying events. If your doctor or hospital leaves your health plan, you must find a new participating provider in your chosen plan.

Check if your doctors participate in the plan

Find out if the doctors’ affiliated hospitals are in the plan

Keep in Mind: Doctors and hospitals can leave a plan during the year, usually because of health plan and provider contract issues, practice mergers, retirement or relocation.

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